Listas para Publicar en el Portal-1 (2) - Triple-S Salud
Listas para Publicar en el Portal-1 (2) - Triple-S Salud
Listas para Publicar en el Portal-1 (2) - Triple-S Salud
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Procedure &<br />
Place of Service<br />
Tarifas<br />
Servicios de <strong>Salud</strong><br />
Description Fee<br />
58120-00 d&c dx&/ther $146.25<br />
58140-00 myomectomy 1-4 250 gm abdl $555.75<br />
58145-00 myomectomy 1-4 250 gm/< vag $546.00<br />
58146-00 myomectomy 5+ > 250 gm abdl $752.90<br />
58150-00 tah +-rmvl tube +-rmvl ovary $585.00<br />
58152-00 tah +-rmvl tube ovary colpo-urtcstopexy $754.65<br />
58180-00 supracrv abdl hyst +-rmvl tube ovary $536.25<br />
58200-00 tah w/prtl vagnc p<strong>el</strong> lymph node sampling $672.75<br />
58210-00 rad abdl hyst w/bi p<strong>el</strong> lmphadec $975.00<br />
58240-00 p<strong>el</strong> exntj gynecologic mal $1,984.13<br />
58260-00 vag hyst 250 gm/< $585.00<br />
58262-00 vag hyst 250 gm/< w/rmvl tube&/ovary $636.68<br />
58263-00 vag hyst 250 gm/< w/rmvl tube ovary w/rpr ntrcl $833.63<br />
58267-00 vag hyst 250 gm/< w/colpo-urtcstopexy $804.38<br />
58270-00 vag hyst 250 gm/< w/rpr ntrcl $672.75<br />
58275-00 vag hyst w/tot/prtl vagnc $697.13<br />
58280-00 vag hyst w/tot/prtl vagnc w/rpr ntrcl $697.13<br />
58285-00 vag hyst rad schauta $926.25<br />
58290-00 vaginal hysterectomy uterus > 250 gm $753.19<br />
58291-00 vag hyst > 250 gm rmvl tube&/ovary $827.48<br />
58292-00 vag hyst > 250 gm rmvl tube&/ovary w/rpr ntrcl $876.62<br />
58293-00 vag hyst > 250 gm colpo-urtcstopexy +-ndsc ctrl $910.85<br />
58294-00 vag hyst > 250 gm rpr ntrcl $807.30<br />
58321-00 artif insemination intra-crv $87.75<br />
58322-00 artif insemination intra-uterine $131.63<br />
58323-00 sprm washg artif insemination $22.43<br />
58340-00 cathj&intro saline nfs shg/hsg $29.25<br />
58346-00 insj heyman capsls clinical brachytx $286.07<br />
58350-00 chromotubation ovidux matrls $29.25<br />
58353-00 <strong>en</strong>dometrial abltj thermal w/o hysteroscopic gid $157.95<br />
58356-00 <strong>en</strong>dometrial cryoabltj us curtg $356.27<br />
58400-00 uterine ssp spx $390.00<br />
58410-00 uterine ssp presac sympth $438.75<br />
58520-00 hysterorrhaphy rpr rptd $390.00<br />
58540-00 hysteroplasty rpr uterine anomal $546.00<br />
58541-00 laps supracrv hyst 250 g/< $569.50<br />
58542-00 laps supracrv hyst 250 g/< rmvl tube/ovary $630.05<br />
58543-00 laps supracrv hyst >250 g $640.58<br />
58544-00 laps supracrv hyst >250 g rmvl tube/ovary $694.10<br />
58545-00 laps myomectomy exc 1-4 250 gm/< $605.48<br />
58546-00 laps myomectomy exc 5+ > 250 grams $762.55<br />
58548-00 laps w/rad hyst w/bilat lmphadec rmvl tube/ovary $1,432.96<br />
58550-00 laps w/vag hyst 250 gm/< $322.73<br />
58552-00 laps w/vag hyst 250 gm/< rmvl tube&/ovary $589.68<br />
58553-00 laps w/vag hyst > 250 grams $759.04<br />
58554-00 laps vag hyst > 250 gm rmvl tube&/ovary $750.26<br />
58555-00 hystsc dx spx $78.00<br />
58558-00 hystsc bx <strong>en</strong>dometrium&/polypc +-d&c $197.44<br />
58559-00 hystsc lss intrauterine ads $219.38<br />
58560-00 hystsc div/rescj intrauterine septum $300.30<br />
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